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Case Management Specialist RN - PD (Bilingual)
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$71.52 - $87.52 an hour
Full-time
- In conjunction with the Physician, implements care/treatment plan by coordinating access to health services across multiple providers/disciplines, monitors care, makes determination to arrange transportation and transfer patient if indicated, identifies cost-effective measures, makes recommendations for alternative levels of care and utilization of resources, promotes self-care management and ensures paper work is completed.
- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families.
- Acts as a clinical liaison, per their specialty, with outside agencies such as County CCS, non-plan facilities, outside providers, employers and/or workers compensation carriers and third party administrators.
- Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
- Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers and outside agencies.
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